How are hospitals in England, Scotland and Wales caring for women with nausea and vomiting in pregnancy: a national service evaluation

Nausea and vomiting of pregnancy (NVP) affects up to 90% of pregnant women but many struggle to access guideline-recommended care. Following a King’s Policy Institute policy laboratory, arranged to explore barriers to care, it was recommended that a scoping review of current national practice was carried out. This study aims to describe NVP services in England, Scotland and Wales and compare management to national guidance. An online survey was distributed to all 139 maternity units in England, Scotland and Wales using freedom of information services. Data were downloaded onto an Excel spreadsheet and statistical analysis performed using GraphPad Prism 10. Responses were received from 129/139 hospitals giving a response rate of 92.8%. Routine screening for NVP/HG at a woman’s booking visit is offered in 37/129 (28.7%) of the hospitals. Treatment in the community was offered in 19/129 (14.8%) and ambulatory management available in 108/129 (83.7%) of hospitals that responded. As per RCOG guidance only 60/129 (47%) of hospitals correctly prescribe a combination of recommended first, second and third-line antiemetics and whether the maternity unit is secondary or tertiary, or whether patients are primarily managed in an obstetric or gynaecology setting, does not influence provision of guideline-recommended care, (secondary 39/85 (45.8%) vs. tertiary 21/44 (47.7%) p = 0.84 and obstetric 12/34 (35.3%) vs. gynaecology setting 48/95 (50.5%) p = 0.13, respectively). A proton pump inhibitor was prescribed in 64/129 (49.6%) of units and thiamine for patients with persistent vomiting in 90/129 (69.8%). Guideline-recommend intravenous fluid management (0.9% normal saline) is used in 93/129 (72.1%) of units. In those where it is not, 5/36 (13.9%) use dextrose solution (recognised to precipitate Wernicke’s encephalopathy). Routine mental health screening occurs in 54/129 (41.9%) of units. Pre-pregnancy counselling is offered to women with a history of severe NVP/HG planning a future pregnancy in 22/129 (17.1%) of units. Significant variation in HG care exists across England, Scotland and Wales. Despite guidance published by the RCOG the treatment women currently receive is not routinely evidence-based and in some cases has potential to cause harm.